Nurse Telephone Triage Research Articles

Telephone triage service use is associated with better outcomes among patients with cerebrovascular diseases: a propensity score analysis using population-based data.

The telephone triage service is an emergency medical system through which citizens consult telephone triage nurses regarding illness, and the nurses determine the urgency and need for an ambulance. Despite being introduced in several countries, its impact on emergency patients has not been reported. We aimed to determine the effect of the telephone triage service on the outcomes of hospitalized patients diagnosed with cerebrovascular disease upon arrival after being transported by an ambulance. This retrospective study included patients with cerebrovascular disease who were transported by ambulance between January 2016 and December 2019. The primary outcome was discharge to home by day 21 of hospitalization. A total of 344 patients who used the telephone triage service were propensity score-matched to 344 patients who directly called for an ambulance. Telephone triage service use was associated with discharge to home by hospital day 21 (crude odd ratio: 1.8; 95% confidence interval: 1.3-2.4) and was not significantly associated with survival on hospital day 21 in multivariate regression analysis. The prognoses of cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage depend on the time from symptom onset to treatment. Telephone triage services may allow patients to receive treatment more rapidly than traditional ambulance requests, resulting in improved patient outcomes. The findings of this study suggest that the use of telephone triage services is associated with improved outcomes in patients with cerebrovascular disease and indicate that the costs for medical expenses and disability may be greatly reduced in an aging society.

Evaluation of the Consequences and Costs of the Anglo-American System in the Pre-Hospital Emergency Department of Yazd in 2018

Background: One of the most important tasks of health care managers is allocateing resources, controling them and ensuring their effective use when available. This study examines the consequences and costs of emergency services in Yazd in 2018.
 Methods: This was a descriptive-analytical study performed on patients of 11 centers in Yazd in 2018. The population of the city was approximately 750,000 in 2018 (1). Direct and indirect costs were extracted, and the consequences and costs of Yazd emergency in 2018 were calculated in riyal and Dollars.
 Results: This study showed that in 2018, out of 173154 contacts, 37988 cases led to the dispatch of an ambulance, and the response rate was 18 %. The rate of hospitalization was 52 %. The average time of dispatch in Yazd pre-hospital emergency department was (10:48) in 2018. Of the 59 high-risk patients who were transported to Yazd's pre-hospital emergency in 2018, 5 patients had successful cardiopulmonary resuscitation(discharge from the hospital). In other words, effectiveness and saving people from death was 8.4 %. Depreciation costs in the pre-hospital emergency department of Yazd in 2018 amounted to 65,061 Dollars (9,759,264,923 Rial). The cost of personnel salaries and benefits was 39669829 Dollars ( 59504743663 Rial). This amount was about 40 % of the total cost of the year for pre-hospital emergency in Yazd city. The average cost of each mission-dispatch was 25 Dollars (3775967 Rial).
 Conclusion: This study examines the consequences and costs of per hospital emergency department in Yazd in 2018. The high number of unnecessary calls to Yazd emergency department calls for the need to raise public awareness. Moreover, the lack of need to transfer half of these people to hospital requires training and retraining of telephone triage nurses.

Effect of an educational intervention for telephone triage nurses on out-of-hours attendance: a pragmatic randomized controlled study

BackgroundTelephone triage has been established in many countries as a response to the challenge of non-urgent use of out-of-hours primary care services. However, limited evidence is available regarding the effect of training interventions on clinicians’ telephone consultation skills and patient outcomes.MethodsThis was a pragmatic randomized controlled educational intervention for telephone triage nurses in 59 Norwegian out-of-hours general practitioners’ (GPs) cooperatives, serving 59% of the Norwegian population. Computer-generated randomization was performed at the level of out-of-hours GP cooperatives, stratified by the population size. Thirty-two out-of-hours GP cooperatives were randomized to intervention. One cooperative did not accept the invitation to participate in the educational programme, leaving 31 cooperatives in the intervention group. The intervention comprised a 90-minute e-learning course and 90-minute group discussion about respiratory tract infections (RTIs), telephone communication skills and local practices.We aimed to assess the effect of the intervention on out-of-hours attendance and describe the distribution of RTIs between out-of-hours GP cooperatives and list-holding GPs.The outcome was the difference in the number of doctor’s consultations per 1000 inhabitants between the intervention and control groups during the winter months before and after the intervention. A negative binomial regression model was used for the statistical analyses. The model was adjusted for the number of nurses who had participated in the e-learning course, the population size and patients’ age groups, with the out-of-hours GP cooperatives defined as clusters.ResultsThe regression showed that the intervention did not change the number of consultations for RTIs between the two groups of out-of-hours GP cooperatives (incidence rate ratio 0.99, 95% confidence interval 0.91–1.07). The winter season’s out-of-hours patient population was younger and had a higher proportion of RTIs than the patient population in the list-holding GP offices. Laryngitis, sore throat, and pneumonia were the most common diagnoses during the out-of-hours primary care service.ConclusionsThe intervention did not influence the out-of-hours attendance. This finding may be due to the intervention’s limited scope and the intention-to-treat design. Changing a population’s out-of-hours attendance is complicated and needs to be targeted at several organizational levels.

Standardizing Strep Throat Documentation in a Pediatric Outpatient Setting During COVID-19: A Quality Improvement Pilot Project

Clinicians’ nonadherence to the 2012 Infectious Diseases Society of America’s group A streptococcal (GAS) pharyngitis guidelines leads to unnecessary in-person clinic visits, unnecessary use of bacterial testing, and inappropriate antibiotic prescriptions. Quality improvement methodology was used during nurse telephone triage at an outpatient pediatric clinic to standardize nurse documentation to align with the GAS guidelines. This pilot project’s standardization resulted in improved communication among clinicians and decreased unnecessary resource and antibiotic use despite encountering barriers related to COVID-19.

Meeting the Challenges of COVID-19: Evaluation of Nurse-Led Changes to Telephonic Assessment.

The early months of the COVID-19 pandemic caused suspension of physician home visits at our NYC home-based primary care practice as well as disruptions in community-based services homebound patients rely on. This produced gaps in care for a vulnerable patient population that is considered underserved and medically and socially complex. Telephone triage nurses at Mount Sinai Visiting Doctors Program responded to these gaps in care with targeted enhancements to telephonic patient assessment: creating an encrypted email address to receive photographs, the use of two Epic dot phrases to screen and educate regarding COVID-19, assessment of patients' ability to complete a video visit, the reassessment of goals of care, and the assessment of changes in home care services. We surveyed 15 attending physicians in our practice to evaluate primary care providers' opinions regarding changes in nurse telephone triage and how helpful they were in managing patients at home during the early pandemic. We found enhancements to nurse telephone triage were viewed by physicians as beneficial, valuable, and improved patient care. Physicians found changes improved timeliness of care, could improve self-management, helped avoid transfer to emergency department, and helped manage patient care at home. As the pandemic continues and telehealth becomes more widely used, nurse telephone triage may be adaptable to help care for a variety of patient populations during future public health emergencies.

Reliability and validity of an original nurse telephone triage tool for out-of-hours primary care calls: the SALOMON algorithm

ABSTRACT Objectives:Due to the persistent primary care physicians shortage and the substantial increase in their workload, the organization of primary care calls during out-of-hours periods has become an everyday challenge. The SALOMON algorithm is an original nurse telephone triage tool allowing to dispatch patients to the best level of care according to their conditions. This study evaluated its reliability and criterion validity in rea-life settings. Methods:In this 5-year study, out-of-hours primary care calls were dispatched into four categories: Emergency Medical Services Intervention (EMSI), Emergency Department referred Consultation (EDRC), Primary Care Physician Home visit (PCPH), and Primary Care Physician Delayed visit (PCPD). We included data of patients’ triage category, resources, and destination. Patients included into the primary care cohort were classified undertriaged if they had to be redirected to an emergency department (ED). Patients from the ED cohort were considered overtriaged if they did not require at least three diagnostic resources, one emergency-specific treatment or any hospitalization. In the ED cohort, only patients from the University Hospitals were considered. Results:10,207 calls were triaged using the SALOMON tool: 19.2% were classified as EMSI, 15.8% as EDRC, 62.8% as PCPH, and 2.2% as PCPD. The triage was appropriate for 85.5% of the calls with a 14.5% overtriage rate. In the PCPD/PCPH cohort, 96.9% of the calls were accurately triaged and 3.1% were undertriaged. SALOMON sensitivity and specificity reached 76.6% and 98.3%, respectively. Conclusion:SALOMON algorithm is a valid triage tool that has the potential to improve the organization of out-of-hours primary care work.

Outcomes of Integrating Smart Phrase Interface Technology to Improve Cancer Symptom Management

ssessing cancer treatment-related symptoms is challenging for frontline telephone-triage nurses toggling multiple electronic health record (EHR) screens for information on toxicity-risk predictors while simultaneously providing over-the-phone emotional support. Decision-support tools embedded into computer-telephone interface software, called smart phrases, are not widely used nor empirically evaluated for usability and remote symptom management impact.

Relationship between the number of pediatric patients with rotavirus and telephone triage for associated symptoms.

Earlier syndromic surveillance may be effective in preventing the spread of infectious disease. However, there has been no research on syndromic surveillance for rotavirus. The study aimed to assess the relationship between the incidence of rotavirus infections and the number of telephone triages for associated symptoms in pediatric patients under 4years old in Osaka prefecture, Japan. This was a retrospective observational study for which the study period was the 3years between January 2015 and December 2017. We analyzed data on children under 4years old who were triaged by telephone triage nurses using software. The primary endpoint was the number of rotavirus patients under 4years triaged old per week. Using a linear regression model, we calculated the R square value of the regression model to assess the relationship between the number of patients with rotavirus and the number of telephone triages made for associated symptoms. Covariates in the linear regression model were the week number indicating seasonality and the weekly number of telephone triages related to rotavirus symptoms such as stomachache and vomiting. During the study period, there were 102,336 patients with rotavirus, and the number of people triaged by telephone was 123,720. The highest correlation coefficient was 0.921 in the regression model with the number of telephone triages for "stomachache+nausea/vomiting" and "stomachache+diarrhea+nausea/vomiting". The number of telephone triage symptoms was positively related to the incidence of pediatric patients with rotavirus in a large metropolitan area of Japan.

Tinkering and overruling the computer decision support system: Working strategies of telephone triage nurses who assess the urgency of callers suspected of having an acute cardiac event.

To understand clinical reasoning and decision-making of triage nurses during telephone conversations with callers suspected of having acute cardiac events, and support from a computer decision support system (CDSS) herewith. In telephone triage, nurses assess the urgency of callers' conditions with clinical reasoning, often supported by CDSS. The use of CDSS may trigger interactional workability dilemmas. Qualitative study using principles of a grounded theory approach following COREQ criteria for qualitative research. Audio-stimulated recall interviews were conducted amongst twenty-four telephone triage nurses at nine out-of-hours primary care centres (OHS-PC). Telephone triage nurses use clinical reasoning elements for urgency assessment. Typically in telephone triage, they interpret the vocal-but not worded-elements in communication (paralanguage) such as tone of voice and shortness of breath and create a mental image to compensate for lack of visual information. We confirmed that interactional workability dilemmas occur. Congruence, established when the CDSS supports the triage nurses' decision-making, is essential for the CDSS' value. If congruence is absent, triage nurses may apply four working strategies: (a) tinker to make CDSS final recommendation align with their own assessment, (b) overrule the CDSS recommendation, (c) comply with the CDSS recommendation or (d) transfer responsibility to the GP. Triage nurses who assess urgency may experience absence of congruence between the CDSS and their decision-making. Awareness of how triage nurses reason and make decisions about urgency and what aspects influence their working strategies can help in achieving optimal triage of callers suspected of acute cardiac events at OHS-PC. Triage nurses' reasoning and their working strategies are vital for outcome of triage decisions. Understanding these processes is essential for CDSS developers and OHS-PC managers, who should value how triage nurses interact with the CDSS, while they have the benefit of callers in mind.

Potential of a nurse telephone triage line to direct elderly to appropriate health care settings.

To explore the potential of a nurse health triage telephone line to advise and guide elderly users' decisions regarding the appropriate health care setting and self-care. Ageing is a concern in many countries and poses challenges to health care services. Triage and advice lines can play an important role for the (re)organisation of health care delivery. Discussion has been focused on the capacity of these lines to reduce inappropriate demand for acute and emergency departments. Cross-sectional descriptive analysis. Nurses directed elders to a health care service both by downgrading their initial intentions (concurring to the most common objective) and by upgrading them (e.g., directing elders that intended to stay at home to acute and emergency care). The intention to comply with the nurse's disposition was high. The line helped to improve the appropriateness of acute and emergency care demand and to reduce the overall demand for care by elders. There is nonetheless space for improvement given the underuse of the line by elders. Health telephone-based triage and advice should be promoted to increase the match between the needs of elderly patients and health resources, thus improving health equity.

Estimating Weekly Call Volume to a National Nurse Telephone Triage Line in an Influenza Pandemic.

Telephone nurse triage lines, such as the Centers for Disease Control and Prevention's (CDC) Flu on Call®, a national nurse triage line, may help reduce the surge in demand for health care during an influenza pandemic by triaging callers, providing advice about clinical care and information about the pandemic, and providing access to prescription antiviral medication. We developed a Call Volume Projection Tool to estimate national call volume to Flu on Call® during an influenza pandemic. The tool incorporates 2 influenza clinical attack rates (20% and 30%), 4 different levels of pandemic severity, and different initial "seed numbers" of cases (10 or 100), and it allows variation in which week the nurse triage line opens. The tool calculates call volume by using call-to-hospitalization ratios based on pandemic severity. We derived data on nurse triage line calls and call-to-hospitalization ratios from experience with the 2009 Minnesota FluLine nurse triage line. Assuming a 20% clinical attack rate and a case hospitalization rate of 0.8% to 1.5% (1968-like pandemic severity), we estimated the nationwide number of calls during the peak week of the pandemic to range from 1,551,882 to 3,523,902. Assuming a more severe 1957-like pandemic (case hospitalization rate = 1.5% to 3.0%), the national number of calls during the peak week of the pandemic ranged from 2,909,778 to 7,047,804. These results will aid in planning and developing nurse triage lines at both the national and state levels for use during a future influenza pandemic.

Do callers of young children with fever follow the self-care recommendations given by a nursing triage line?

IntroductionThe management of fever can be a stressful situation for caregivers of young children. Accessing emergency departments and urgent care centres (ED/UCCs) due to concerns about fever and the potential consequences of child fever is common, despite fever rarely being considered a medical emergency.
 Objectives and ApproachDetermine the non-compliance rate with public health advice for self-care at home for young children (3-35 months) with a fever. Non-compliance was defined based on the presence of a record of healthcare use within 72 hours following a call to a nurse telephone triage line, Health Link (HL), and receiving a self-care recommendation. Callers between October 2015-March 2016 were identified and linked with four databases: registry files, National Ambulatory Care Reporting System; Inpatient-Discharge Abstract Database and Physician Claims (N = 879). Overall non-compliance rate and descriptive analysis by child age, caregiver age, geography, and call time were completed.
 ResultsThe overall non-compliance rate with HL advice was 35.6%. Among callers, 17.5% visited an ED/UCC, 1.1% had an inpatient hospital admission, and 21.3% visited a physician’s office. Among the patients that utilized health care services after the HL call, 13.6% only visited ED/UCC, 18% only visited a physician’s office, and 4% utilized more than one type of health care service. Callers in rural and rural remote areas had lower odds of visiting a physician’s office compared to the urban areas (p-value <0.01). No significant differences were found by child age, caregiver age or time of call.
 Conclusion/ImplicationsFindings of this study suggest that approximately one-third of callers are not following the telephone triage advice, potentially leading to unnecessary increased burden on the healthcare system. Further study is warranted to examine reasons for non-compliance. Strategies to increase compliance in caregivers should be explored.

Seasonal Variation in Pediatric Chronic Pain Clinic Phone Triage Call Volume

Chronic pain is highly prevalent in youth and often results in significant health care usage and familial distress. Telephone triage nurses in pediatric pain clinics provide support and consultation to families and engage parents of pediatric pain patients in interdisciplinary intervention efforts. Despite evidence of winter predominance in rates of pain-related and psychiatric complaints, seasonal variations have not been examined in terms of the demand placed on pain clinic triage nurses. The present study investigated seasonal patterns in the frequency and type of phone calls made over the course of 1 year to an interdisciplinary outpatient pediatric chronic pain clinic at a large Midwestern children's hospital. Pain complaints, reasons for phone calls, and call outcomes (e.g., medication changes, consultation with medical or mental health providers) were recorded in patient charts and retrospectively reviewed by the clinic registered nurse. A total of 721 calls regarding 253 patients were made over the course of 1 year. Results indicated that overall call volume across pain conditions was more than two times greater in the winter than in the summer (χ2 = 64.13, p < .001), and the odds of a call involving headache pain were almost twice as likely in the winter as in the summer. The majority of calls required consultation with physicians and/or mental health providers. Present data may be useful for pediatric chronic pain clinics making staffing decisions throughout the year because the winter season appears to place a significantly greater demand on triage nurses.

Telephone triage by nurses

A survey study carried out as part of a randomised trial of GP and nurse telephone triage (ESTEEM) in 15 general practices in England investigated the relationship of the nurse professional characteristics with the proportion of triaged patients recommended for inpractice follow up. This outcome represents the rate of consultations not completed by phone.

Applying a human factors approach to improve usability of a decision support system in tele-nursing

Summary Aim To evaluate usability of a decision support system for telephone triage nurses. Background Telephone triage by nurses has become an internationally accepted form of health service delivery to cope with increasing demands on primary and emergency care. Decision support software systems are used by nurses to facilitate the telephone triage process, yet, the usability of these systems is rarely assessed. Method We applied a multi-method human factors approach to evaluate the usability of decision support software used by Healthdirect Australia nurses during telephone triage. Methods included: (1) stakeholder discussions; (2) heurstic analysis by two independent experts across ten usability heuristics; and (3) interviews with system end users ( n =9). A list of heuristic violations with their severity ratings was developed. Qualitative content analysis of the interview transcripts was undertaken to validate the results of the heuristic evaluation. Findings Forty one unique heuristic violations were identified in the interface design of the decision support software with median severity of 2.25 (range 0–4, with 0=no problem to 4=catastrophic problem). The highest number of violations was observed for flexibility and efficiency of use ( n =12, median severity=2.5) and for aesthetic and minimalist design ( n =11, median severity=2). Interviews with nurses verified many of the violations identified in the heuristic analysis. Improving the navigational design of the system for flexibility and efficiency of use was identified as necessary by both the experts and end users. Conclusion In adopting a multi-method human factors approach, we identified a number of system design features which may be impacting on the safety and efficiency of the nurse telephone triage process. Addressing the identified usability issues and using feedback from end-users to modify the decision support system would optimise system use and so improve the triage process.

Parent perspectives and reasons for lower urgency paediatric presentations to emergency departments.

The age band with, by far, the greatest number of ED presentations is children 0-4 years, with other paediatric age bands also among the highest. As the majority of these presentations are for lower urgency conditions, we sought to determine why parents seek ED care for their child for lower urgency conditions. A survey study of 1150 parents or guardians of children with lower urgency conditions (triage category 4 or 5) presenting to the EDs of three public general and one paediatric specialty hospital in metropolitan Melbourne. Fewer than half of parents (43%) attempted to make an appointment with a general practitioner (GP) for their child prior to presenting to the ED. Two-thirds of those who did contact a GP were instructed by their GP to go to the ED for their lower urgency condition. Few attempted to contact a nurse telephone triage service or after-hours GP service. The current magnitude and the growth of lower urgency paediatric ED presentations is a strain on the health care system. Efforts to educate parents regarding the suitability and availability of GP appointments can be the cornerstone of an initial strategy to address this issue. However, efforts to address the high rates of GP referral to EDs for low urgency presentations will be more vexing to develop, yet no less important. They will require addressing fundamental issues in both current GP care for children and the training of GP registrars.

The effect of nurses’ preparedness and nurse practitioner status on triage call management in primary care: A secondary analysis of cross-sectional data from the ESTEEM trial

BackgroundNurse-led telephone triage is increasingly used to manage demand for general practitioner consultations in UK general practice. Previous studies are equivocal about the relationship between clinical experience and the call outcomes of nurse triage. Most research is limited to investigating nurse telephone triage in out-of-hours settings. ObjectiveTo investigate whether the professional characteristics of primary care nurses undertaking computer decision supported software telephone triage are related to call disposition. DesignQuestionnaire survey of nurses delivering the nurse intervention arm of the ESTEEM trial, to capture role type (practice nurse or nurse practitioner), prescriber status, number of years’ nursing experience, graduate status, previous experience of triage, and perceived preparedness for triage.Our main outcome was the proportion of triaged patients recommended for follow-up within the practice (call disposition), including all contact types (face-to-face, telephone or home visit), by a general practitioner or nurse. Settings15 general practices and 7012 patients receiving the nurse triage intervention in four regions of the UK. Participants45 nurse practitioners and practice nurse trained in the use of clinical decision support software. MethodsWe investigated the associations between nursing characteristics and triage call disposition for patient ‘same-day’ appointment requests in general practice using multivariable logistic regression modelling. ResultsValid responses from 35 nurses (78%) from 14 practices: 31/35 (89%) had ≥10 years’ experience with 24/35 (69%) having ≥20 years. Most patient contacts (3842/4605; 86%) were recommended for follow-up within the practice. Nurse practitioners were less likely to recommend patients for follow-up odds ratio 0.19, 95% confidence interval 0.07; 0.49 than practice nurses. Nurses who reported that their previous experience had prepared them less well for triage were more likely to recommend patients for follow-up (OR 3.17, 95% CI 1.18–5.55). ConclusionNurse characteristics were associated with disposition of triage calls to within practice follow-up. Nurse practitioners or those who reported feeling ‘more prepared’ for the role were more likely to manage the call definitively. Practices considering nurse triage should ensure that nurses transitioning into new roles feel adequately prepared. While standardised training is necessary, it may not be sufficient to ensure successful implementation.

The effect of Cincinnati Prehospital Stroke Scale on telephone triage of stroke patients: evidence-based practice in emergency medical services.

The emergency medical service is designed to recognize and transfer critically ill patients. Evidence-based practice has rarely been emphasized in the emergency medical service field, especially in the dispatch center. To identify the effect of the Cincinnati Prehospital Stroke Scale (CPSS) on telephone triage of stroke patients by telephone triage nurses at the emergency medical dispatch center and to compare CPSS with the National Guidelines for Telephone Triage Tool (NGTT). A quasi-empirical study was conducted from June 2013 to June 2014. The setting of the study was the Mashhad dispatch center of the EMS. Two hundred and forty-six patients were randomly allocated to the CPSS intervention group (n = 121) and the NGTT control group (n = 125). True triage, triage error and odds ratio were statistically reported. The mean age of the patients was 70.9 ± 12.7 years. Of all the cases, 77.7 and 65.6% of patients in the intervention and the control groups, respectively, were accurately triaged. Under-triage cases were 10.7 and 13.6% of the patients in the intervention and the control groups. Odds ratio was 1.14 (95% confidence interval 0.62-2.07) for the CPSS compared with the NGTT. CPSS is more efficient for use by telephone triage nurses in identifying stroke. The use of CPSS assists nurses by reducing the triage error and supports the evidence-based care. It needs to be developed to cover signs and symptoms of posterior-circulation stroke patients.

Distance from practice moderates the relationship between patient management involving nurse telephone triage consulting and patient satisfaction with care

The ESTEEM trial was a randomised-controlled trial of telephone triage consultations in general practice. We conducted exploratory analyses on data from 9154 patients from 42 UK general practices who returned a questionnaire containing self-reported ratings of satisfaction with care following a request for a same-day consultation. Mode of care was identified through case notes review. There were seven main types: a GP face-to-face consultation, GP or nurse telephone triage consultation with no subsequent same day care, or a GP or nurse telephone triage consultation with a subsequent face-to-face consultation with a GP or a nurse. We investigated the contribution of mode of care to patient satisfaction and distance between the patient׳s home and the practice as a potential moderating factor. There was no overall association between patient satisfaction and distance from practice. However, patients managed by a nurse telephone consultation showed lowest levels of satisfaction, and satisfaction for this group of patients increased the further they lived from the practice. There was no association between any of the other modes of management and distance from practice.

Communicative Practices in Nurse vs. GP-Led Telephone Triage: A Comparative Investigation

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)The IJIC 20th Anniversary Issue was published in 2021.